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Coagulopathy

A bleeding disorder (coagulopathy) is a condition that affects the way the blood clots. It is characterised by prolonged/excessive bleeding following injury or medical and dental procedures [1]. In some instances spontaneous bleeding can occur into joints, muscles or other parts of the body.[2] Irregular clotting can be due to deficiencies and defects in blood platelets and/or clotting factors[3]. The body produces 13 clotting factors [4]. Blood clotting is affected if any of the clotting factors are deficient or defective.[5]

Bleeding disorders can be inherited or acquired. Others can occur from conditions such as anemia, cirrhosis of the liver, HIV, leukemia and vitamin K deficiency. They also can result from certain medications that thin the blood, including antiplatelet and anticoagulant medications.

Examples of inherited bleeding disorders include Haemophilia A, Haemophilia B[6] and von Willebrand Disease.[7] Bleeding disorders can be acquired due to antiplatelet and anticoagulant medications that are taken for the prophylaxis and treatment of medical conditions such as Atrial Fibrillation, deep vein thrombosis (DVT), Stroke, Pulmonary Embolism and heart attack[8]. Examples of these medications include Aspirin and Clopidogrel (antiplatelets), Warfarin (anticoagulant) and Novel Oral Anticoagulant medications (NOACs) such as Rivaroxaban[9], Apixaban[10] and Dabigatran.[11]

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Coagulopathy may cause uncontrolled internal or external bleeding. Left untreated, uncontrolled bleeding may cause damage to joints, muscles, or internal organs and may be life-threatening. People should seek immediate medical care for serious symptoms, including heavy external bleeding, blood in the urine or stool, double vision, severe head or neck pain, repeated vomiting, difficulty walking, convulsions, or seizures. They should seek prompt medical care if they experience mild but unstoppable external bleeding or joint swelling and stiffness.[citation needed]

The normal clotting process depends on the interplay of various proteins in the blood. Coagulopathy may be caused by reduced levels or absence of blood-clotting proteins, known as clotting factors or coagulation factors. Genetic disorders, such as hemophilia and Von Willebrand's disease, can cause a reduction in clotting factors.[12]

Anticoagulants such as warfarin will also prevent clots from forming properly.[12] Coagulopathy may also occur as a result of dysfunction or reduced levels of platelets (small disk-shaped bodies in the bloodstream that aid in the clotting process).[citation needed]

If someone has coagulopathy, their health care provider may help them manage their symptoms with medications or replacement therapy. In replacement therapy, the reduced or absent clotting factors are replaced with proteins derived from human blood or created in the laboratory. This therapy may be given either to treat bleeding that has already begun or to prevent bleeding from occurring.[citation needed]

One area of treatment is managing people with major bleeding in a critical setting, like an emergency department.[13] In these situations, the common treatment is transfusing a combination of red cells with one of the following options:[citation needed]